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CMS Family Assurance of Student Health Agreement
Electronically signing and submitting this form means that you agree to the following:
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Email
*
Your email
Please review this information before signing and agreeing below:
Student Name (first and last)
*
Your answer
Parent/Guardian Signature (type your first and last name)
*
Your answer
Date
*
MM
/
DD
/
YYYY
If you have more than one student at CMS, please fill out a separate form for each child.
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